Permit u CITY OF TIGARD ELECTRICAL PERMIT
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2 <'- COMMUNITY DEVELOPMENT Permit #: ELC2013 00175
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/19/2013
Parcel: 1 S 134AA01800
Jurisdiction: Tigard
Site address: 10110 SW NIMBUS AVE B6
Project: Impact Medical Subdivision: IKOLL BUSINESS CENTER, TIGARD Lot: 2
Project Description: (2) branch circuits for lights and switches
Contractor: WINNER ELECTRIC INC Owner: HANSON, RONALD D
5950 SW PROSPERITY PK ROBINSON, CONSTANCE A
TUALATIN, OR 97062 ROBINSON, CHESTER TRUST ET AL
203604 EAST FINLEY RD
KENNEWICK, WA 99331
PHONE: 503 - 638 -5028 PHONE:
FAX: 503 - 638 -4242
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/19/2013 $63.60
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 03/19/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp: • .
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in a - with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT- 'TION: Oreg•• la - quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -.010 through OAR 9.: - 001 -00- i ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issu•d By: � � � 4 �� / •/ \ , Permittee Signature: /� (Of ( 1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
• SIGNATURE OF SUPR. ELEC' ( ��" U3°J Date: 5( /i3
LICENSE NO. 1'1 5' S
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C all 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a place on the Job site until completion of the project. .
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Applicati r ONLY
of Tigard �E Received
Permit No.: / FOR OFFICE USE O g'4V..pcy5 ch i ?
. � -
City DateB ��/
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.19�1IAR 1 9 2 013 Date : Other Permit: he P 3 3 .-oce ,
Ti G AR D Inspection Line: 503.639.4175 Date Ready/By: Juris: 0 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF Bd DING DIVISION PLAN REVIEW
❑ New construction Ical Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: / e 100HP or more. occupancy.
d // d S l t) N i nt VS ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: 9 p21 4.13„ /� 01. `ti . f` ,� ❑ Health-care facilities. ❑ Supply voltage for more than
�` v ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 16'j Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: a P.,r s3/ Js p,oa_ J a) Description I Qty. I Poe. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 l
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75 00 2
7HSA 11 GI Ca b / ( 3 L/ 4 . r " ' residential (with above sq. ft.)
/ Services or feeders installation, alteration, and/or relocation
2(4 ,sta to -1 200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first r 56.18 6 ,(8 2
Contact name: branch circuit
Each add'/ branch circuit / 7.42 7.Y0 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: p 1 L panel, alteration, or extension. Page 2 2
(,VI OA) eft- P / Pure /c' p Each additional inspection over allowable in any of the above
Address: S) 50 � eR 0 S p P v --. -t �- Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: �p L Investigation (1 hr min) 66.25/ hr
�v4 �Xl`7 1 9 70 Industrial plant (1 hr min) 78.18/ hr
Phone: (503 ) 63s 50 e p Fax: (a ) 6sg (1a %) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr nun)
CCB Lic.: / 7 2 Electrical Lie.: 34/_h69 c Suprv. Lie.: auss ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: OA, ( 0 Subtotal: g3,40 Plan review (25% of permit tee):
Print name: V fi Ck lid R 0 Date: 3 _ i e - /3 State surcharge (12% of permit fee): 743
TOTAL PERMIT FEE: "l iTr /J
Authorized signature: This permit application expires if a permit is not obtained wifhin 1
Print name: Date: • days after it has been accepted as comr
Number of inspections allowed per permit.
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